PT on the Net Research

Chondromalacia and Exercises


Question:

My client just found out she has chondromalacia. She is seeing a PT for the condition, but I wondered if you could give me more on what it is and any exercises you might recommend?

Answer:

Let us first discuss the definition of chondromalacia. It is a condition where there is a degeneration of the cartilage on the inside of the patella or kneecap. The degeneration is caused from an abnormal shearing force on the knee joint. Because she is seeing a physical therapist, I would suggest calling the PT and seeing what techniques are currently being used. Quite often traditional rehabilitation will involve stretching the IT band and strengthening the vastus medialis obliques or VMO. This is not a bad first step, but we can make it much more effective by adding a couple of steps to it. I believe the first person in the fitness world that termed this movement pattern was Mike Clark. He coined the generic term ‘pronation’ as the movement pattern involved with deceleration of forces in the kinetic chain. What this means in simple terms is that the body will move and react to the ground in predictable patterns. When there are certain muscles that aren’t functioning as well as they should, then predictable patterns of dysfunction will occur as well. In many cases, the excessive shear force at the knee is caused from a lack of strength in the glutes, with special note on the glute medius. The glute medius and glute maximus are functionally responsible for decelerating femoral internal rotation at heel strike and mid stance of the gait cycle or walking sequence. Since the glute medius is not working effectively the femur will internally rotate more than is necessary which will cause an excessive shear force at the knee. Shear force just means that there is a force being applied in a different direction than the joint is made to handle. Since the femur is rotating excessively towards the mid line of the body, and the patella is supposed to track straight up in down, the forces do not line up, thus shear force. This rotation at the femur, and the straight up and down path of the patella is causing the cartilage on the inside of patella to degenerate. Coupled with the internal rotation of the femur is the lengthening or weakening of the VMO. This occurs because the function of the VMO is to decelerate the femoral internal rotation, also. The problem is that it is not strong enough to do it on its own. It needs help from the gluteus medius or it will become overloaded and stretch out, which it probably did. Another protective mechanism of the body is the tensor fascia latae or TFL will contract to help out for the weakened gluteus medius. Because the TFL is connected to the IT band, it tightens the IT band. Now we can focus on what exercises may help.

First, we must focus on stretching the tight muscles and strengthening the loose ones. I would invest in a foam roller. You may purchase one from the Perform Better Shop on the PTN Shopping Mall. Have your client roll on their IT band. This will help the lengthening process. Start off slowly because there may be some discomfort involved. We next need to focus on strengthening the glute medius. One of the best ways to strengthen the glute medius is to do exercises while standing on one leg. Be sure to keep the pelvis neutral. If you let the pelvis drop, the glute medius is rendered ineffective. Try to do your traditional exercises standing up using cables. Any primary movement: pushing, pulling, squatting, rotating etc. can be done standing. You can use any cable pulley system to accomplish these movements. We use the Free Motion cable cross for its ease in adjusting. There are a plethora of exercises in the exercise library showing the use of cables for your exercise needs. The one exercise I have used most effectively for anyone with the condition described is the opposite arm, one- legged squat touchdown. While standing on one leg, take the opposite side arm and try to touch the outside of the planted leg’s foot. Make sure that the knee on side doing the squat stays tracking over the second and third toe. Don’t sacrifice form for depth. If the client can only go down 6 inches before the knee goes off track, have the client only go down 6 inches. Just have them concentrate on really contracting their glutes throughout the movement. Without getting too much in depth, also try to be aware of the arch in their foot. While standing on one leg for any exercise and especially during the one legged squat, try to make sure they maintain an arch in their foot. This will often require them to squeeze their toes and try to grip the ground. Always remember that personal trainers are not doctors or therapists.